The New Yorker magazine recently published a piece, titled “The political fight against polio”. This article, reviewing current challenges in polio eradication in Nigeria and conflict ridden areas in general, argues that the polio prevention “plot [got] messy” and has become at least as much of a political, as an epidemiological issue because of its geography. But has polio ever been anything but political? And has it always been a fight?

Polio is a relatively new disease. It started to appear in epidemic waves in the late 19th and early 20th century, and by the 1950s it became a global issue. By then, the epidemic waves became more and more severe and vaccine development saw funding and international cooperation as never before. The stakes were high: this disease spared no-one, it affected rich and poor all the same. Most importantly, polio was (and is) primarily a childhood disease, hence its older name, infant paralysis – a name that is still the official term used in a number of languages. It’s a disease that can cause permanent paralysis, most often in the limbs and occasionally in the respiratory muscles.

Polio’s threat of debilitating future generations was most acutely felt in post-war societies, especially those that suffered a significant blow to their population in World War II. In countries scrambling out of destruction, bracing themselves for a new, albeit Cold War, polio decidedly became political as well as a fight. It is this, post-war setting that ultimately set the tone for the last 60 years of polio. The prevention of contagious diseases became proxy-wars in the Cold War, as in the case of malaria, as Marcos Cueto’s and Randall Packard’s work show. Polio treatment also became a “fight”, whether, as David Serlin points out, encapsulating ideas of heroic masculinity in the West, or as a struggle with the state and its ideologies in the East.

Political agendas have also been ever-present in preventing and treating the disease. These politics are, on the one hand, part of broader perceptions of disease and vaccination, and on the other, are particular to polio. Susan Sontag’s and Emily Martin’s work on AIDS show how contagious diseases are inseparably intertwined with politics. This is, of course, nothing new, Foucault would tell us, pointing to the plague. Even on the level of international disease control, the politics have long played the leading role, as João Rangel de Almeida demonstrates in his research on 19th century efforts.

Perhaps one of the most interesting aspect of the political in the case of polio is its perception as being non-political. In some ways similarly to the smallpox eradication campaign, as Erez Manela’s research shows, conflicting sides made an effort to cooperate in global campaigns of disease prevention. While this seemingly apolitical enterprise was, of course, heavily laden with Cold War politics, it brought together scientists, diplomats and public health officials from both sides in meaningful ways. The intense decade of polio research shows us a different face of the Cold war, and, not in the least, the effort did curb the disease on a global scale. As importantly, in the course of polio vaccine development, key players emerged as guarantors of the “apolitical”: the WHO became a major mediator between East and West when it came to the evaluation of the Sabin vaccine based on Soviet results. With this, the agency was making a strong statement against something the Soviets knew all too well: they were the first to demonstrate the importance of politics in the international organization, when they left it on political grounds shortly after it came to life.

The global “fight” against polio therefore has been represented, and, genuinely perceived by many as being apolitical. That this view is not universally shared, though, should not come as a surprise. While many of the issues that contribute to the challenges of today’s eradication efforts are complex with backgrounds of a wide variety, the history of the disease tells us that fears of polio vaccination and reservations about the international agencies behind it are hardly new. But then, this same history also shows that solutions to polio prevention have cropped up in unexpected spaces, and the last 60 years have resulted in a tangible result: that for millions, polio has become a distant memory.

In November 2013, possibly the largest mass grave from the recent Bosnian war was discovered in the village of Tomasica in the vicinity of the East Bosnian city Prijedor – over 470 bodies of Bosniaks and Croats killed by the Serbian forces have been excavated so far, and the excavations are continuing. It is now estimated that the grave contains between 700 and 1000 bodies. The discovery of the Tomasica grave, in a country where over 8000 people are still missing and many war-related issues remain painfully unresolved, provoked a potent reaction of horror, grief, and anger; it forced thousands to re-live their wartime experiences, loss of family members, memories of mass murders and tortures conducted in eastern Bosnia in the early 1990s. In a divided country, the Tomasica events once again brought to the fore the silence of the Serbian political structures on the issue of war crimes, and directed the public’s attention to the numerous problems in the recent functioning of the UN’s ICTY [International Criminal Tribunal for Former Yugoslavia] in The Hague (which, in 2013, marked twenty years since its foundation in). But Tomasica, quickly becoming a most powerful symbol for the trauma of the Bosnian war, has also been symptomatic of the persistence of mental suffering in the war’s aftermath: the person who led the International Commission of Missing Persons investigators to the site of the grave was a Serbian witness – an army conscript ordered to unload dead bodies into the grave from a truck in 1992. He reportedly testified that he could not bear to fight his own demons any further, that he had been seeing a killed Bosnian man’s open eyes following him everywhere, and that his testimony brought him relief. How have the Bosnian and other former Yugoslav societies dealt with psychological traumatization caused by the 1990s wars? How has war trauma shaped the development of those societies in the aftermath of the conflicts?

From the beginning, the Bosnian war has been coached in clear psychiatric terminology. The ideological explanations of the outbreak of the war were tightly related to the discourse of psychiatry and psychoanalysis, and, at the beginning of the conflicts, the central role was played by psychiatrist politicians and their references to trauma and insanity. Serb war politics in both Croatia and Bosnia-Herzegovina was designed by a prominent psychiatrist of Freudian orientation turned Croat Serb leader Dr. Jovan Raskovic and his protégé in Sarajevo Dr. Radovan Karadzic. It was within a decidedly psychiatric and psychoanalytic discourse that both Raskovic and Karadzic conceived of their respective political roles. Both attempted to introduce madness and trauma as central political categories, with the result that post-Communist politics in Yugoslavia became defined as a form of ‘mass psychiatry.’ In Raskovic’s view, ‘For the Serb, the unconscious desire for nation is paramount and has been suppressed by the ideology of class consciousness;’ post-Communist politics thus needed to forge a proper ‘path to the Serbian Oedipal emancipation.’ A proper psychiatric political leadership was thus critical for the success of this project of political transition and national liberation. Within such a carefully crafted medical discourse, even a planned and coordinated act of genocide could be interpreted as the final expression of ‘healthy madness,’ an irrational delirium which emancipated the nation from its own archaic, primitive Other – the Ottoman legacy, the Muslim presence – and set it firmly on the road to modernity and healthy nationalism.

In a very different context, the psychiatric language has persisted well after the war’s end: the interpretations of the conflict and its aftermath still revolve around the theme of open wounds and psychological re-traumatization. The universality of psychological discourse about the Bosnian war has indeed been one of its most striking characteristics: almost every war crimes-related legal decision in both local and international courts tended to provoke a psychologically-termed response from different victims’ groups. The recent acquittals of high-ranking Serbian and Croatian military and political functionaries at The Hague Tribunal led to a number of negative reactions, especially from Bosniak associations, who reported their loss of faith in the tribunal and considered its decisions an insult to their traumatic experiences. The November 2013 decisions of the European Human Rights Court in Strasbourg and the Constitutional Court of Bosnia-Herzegovina to release ten Bosnian Serb war crime convicts – six of whom were accused of participation in the Srebrenica genocide – due to a procedural issue and re-try them, further reinforced the negative atmosphere among survivors: Munira Subasic, who lost twenty-two male family members in Srebrenica, said that she felt victimized all over again, and that the criminals ‘could even be standing behind [her] back.’

The memorial in Srebrenica (source: thetimes.co.uk)

However, in spite of the potency of such language of psychiatry, the post-Yugoslav states have consistently demonstrated their disregard for the actual psychological problems of their populations. In the aftermath of such a brutal war which primarily targeted civilians, psychological traumatization has remained the subject of non-governmental organizations or autonomous victims’ associations and mainly depended on personal initiative, while no organized or systematic state medical assistance was ever implemented; as a result, a great majority never received any psychological help whatsoever. No meaningful policy for dealing with the war trauma was ever formulated, and masses of traumatized citizens were rarely offered any help in dealing with their persisting mental issues – other than the diagnosis of PTSD and meagre financial aid in the case of certain groups of military veterans.

Part of the reason has been, of course, that the wartime destruction has left these states economically impoverished, with state medical services shrinking, of low quality and increasingly corrupt (particularly in Bosnia, whose complex institutions are often paralyzed as a result of manipulations of ethnic politics). But perhaps even more importantly, the countries most deeply involved in the conflicts of the 1990s – Bosnia and Serbia – have failed, for a number of structural reasons, to integrate the memory of the war into their post-conflict self-image and identity narratives. As a consequence, no stable politics towards understanding and treating the 1990s war trauma has emerged: medical interpretations of war-related mental wounds exist in specific social and cultural contexts and tend to be determined by the collective memory of the conflicts in question, reflected through a collective understanding of the place of those conflicts in the society’s history.

Psychiatric and psychological definitions of war trauma in any particular society tend to reflect the dominant socio-political narrative, and are symptomatic of the most pressing problems the society is dealing with. Dealing with psychological traumatization after war involves attempts to fit potential solutions to lingering problems within the dominant narrative. Twentieth century war psychiatry has proven this numerous times, not least in Yugoslavia itself. For example, in the aftermath of WWII, when various Yugoslav populations were dealing with different forms of profound psychological traumatisation, it was soldiers’ trauma that attracted the state’s undivided attention and became the symbol of wartime psychological suffering. What became known as ‘partisan hysteria’ or ‘partisan neurosis’ was a complicated and apparently unique psychiatric condition, which, according to leading Yugoslav psychiatrists of the era, only affected the victorious soldiers of the Communist resistance movement. While in other combatant countries soldiers’ neurosis mainly comprised anxiety states, shivering or combat fatigue, ‘partisan hysteria’ presented a radically different clinical picture. British, American, Canadian or French soldiers, although on the winning side, suffered from a psychiatric disorder which signified their wish to withdraw from the frontlines, and was symptomatic of their fear of and emotional distance from the battles; by contrast, the Yugoslav partisans’ dedication to the war’s causes was reportedly never compromised, not even when they clearly suffered mental consequences: ‘partisan hysteria’ consisted of epileptiform trance-like seizures, during which soldiers re-enacted their battle experiences, yelled, ‘shot’, ran, even gave political speeches, and thereby expressed their ‘fighting spirit’. Once they recovered from their attacks, the ill partisans would usually not remember anything they did or said during the seizures.

According to Yugoslav psychiatrists and members of the political authorities of the new socialist state, the most striking feature of ‘partisan neurosis’ was that it revolved around this ‘fighting spirit’, the partisans’ continued willingness to fight and re-live battlefield experiences. Instead of being a symptom of fear or exhaustion, it demonstrated the Communists’ continued dedication and courage. The constructed uniqueness of partisan neurosis served very well to underline the uniqueness of Yugoslavia’s postwar political and military position – as a socialist country which bred a large, independent and ultimately victorious Communist resistance guerrilla movement. In many ways, the official interpretation of ‘partisan hysteria’ was an advertisement for Marxist politics and what it could do for the military morale: it created soldiers whose commitment did not falter even when they were facing the worst of their demons. While Western armies conscripted soldiers and forced them to the frontlines to fight for the interests of the capitalist state, the Yugoslav partisans were volunteers in a uniquely egalitarian people’s army and their interests were identical to those of their new socialist homeland.

However, the postwar revolutionary Yugoslav realities were also fraught with a series of problems as reflected in political and psychiatric interpretations and clinical treatment of partisan neurosis. While the ‘partisan hysterics’ were heroes, they also became a symbol of the pitfalls and complexities of an increasingly socially mobile society. One of the most pressing concerns of the postwar period concerned massive social and economic dislocations and elite turnover – this was indeed what made the Yugoslav postwar transformations into a veritable social revolution. But difficulties were still rather formidable, and the Communist Party worried about some of its own members, including those with little education and of peasant origins, and their capacities for contributing their fair share to the revolution. This became particularly important since the new political and military elite was now to be recruited from the ranks of peasants and workers. So it turned out that ‘partisan hysteria’ reportedly only affected partisan soldiers of peasant origin and with little if any formal education – precisely those about whose potential the Party itself was so ambivalent. As psychiatrists and psychoanalysts explained, and the Party tended to agree, it was those undereducated and immature (‘primitive’) young soldiers who simply could not deal with the pressure of their new high-ranking positions, and then broke down, using their neurotic seizures to remind others of their past military achievements and abilities. ‘Partisan hysteria’ was thus portrayed as the pathology of the social revolution. Therefore, the psychiatric understanding of WWII soldiers’ trauma and its treatment reflected the official narrative of the war and resistance, and ‘partisan hysteria’ was seen through the lens of Yugoslav society’s main preoccupation. The concept was a symptom of its time, and its psychiatric and political connotations served socio-political and economic functions in the turbulent postwar times.

However, fifty years later, the political and social situation following the wars of Yugoslav secession was radically different, and the wars’ effects, meanings and interpretations remain far from clear. In Bosnia, the divided state structure prevented the emergence of a unified narrative of the conflict, as different groups and political alliances within the country constantly challenge each other’s interpretation of war events and wartime suffering, while victims’ associations remain in the lurch, manipulated, impoverished, forced to regularly re-live their worst experiences and to prove the authenticity of their pain. Indeed, the post-1995 set-up of Bosnia-Herzegovina did not do much to alleviate the re-traumatizing feelings of injustice: the political leadership of one of the two entities, Republika Srpska, remains stubborn in its chauvinistic rhetoric and refusal to take responsibility for wartime massacres and crimes against humanity, and regularly strives to prevent commemorations of the dead and memorializations of war crimes sites (such as former concentration camps) on its territory (in the most recent example of this trend, Hatidza Mehmedovic, of the association ‘Mothers of Srebrenica’, was summoned to the police of the Serbian entity to make a statement regarding her ‘illegal entrance of private property’ after she went to the agricultural cooperative’s hangar in the village of Kravica to pay respects to over one thousand Bosniak men and boys killed there in 1995). Wartime concentration camp internees can still run into their former guards and interrogators in the streets, because only the highest-ranking perpetrators have ever been legally prosecuted. Hundreds of families have been unable to close the war chapter in their lives because the remains of their missing relatives – children, parents, siblings, spouses – have not yet been found or identified. During the war, the Serbian armed groups conducted a campaign of systematic rape, but this crime remains somewhat of a taboo, even now that rape victims have finally been recognized as civilian war victims, after the 2006 Berlin Golden Bear winner film ‘Grbavica’ by Sarajevo’s Jasmila Zbanic brought the issue to the forefront of the country’s political debate.

A scene from the film ‘Grbavica’, by Jasmila Zbanic (source: worldcinema.org)

In Serbia, war veterans from the recent conflicts face similarly formidable obstacles to reintegration in civilian society and especially to receiving sustained state-sponsored medical and psychological help. In this country, the role of perpetrators and questions about individual and social responsibility for mass war crimes has complicated the process of dealing with the memory of the wars. The Serbian state’s ambivalence about its own role in the 1990s wars has resulted in its failure to address the responsibility issues squarely; instead, the country’s governments have continuously chosen to distance themselves from past military involvements and human rights violations, and focus on the (rather uncertain) future of European integration. But this does not only harm the country’s relations with the rest of the region but also leaves former Serbian soldiers in the lurch. Many of the veterans who are now in dire need of psychological assistance have been struggling unsuccessfully with what they saw and did in Bosnia, Kosovo and Croatia, as well as with developing a stable self-image. How do perpetrators mourn their losses and suffering, and how does a society come to terms with its own citizens whose war participation has been marred by mass war crimes? According to her recent PhD dissertation on Serbian war veterans with PTSD, Belgrade clinical psychologist Olivera Markovic noted that the majority were extremely dissatisfied with their current social and economic position, and resented the state’s neglectful treatment of them as a group (as one of her interviewees said, ‘I defended my country as a patriot and became war invalid, but now I see that this is of nobody’s concern …’). The core problem, in Markovic’s opinion, is that their own relationship to their war activities has become deeply ambivalent, due to the Serbian society’s negative evaluation of the wars of Yugoslav secession, and in particular of the wars’ achievements. This in turn shaped the veterans’ perception that their suffering was in vain, which was reinforced by the state’s sustained neglect of their needs or indeed of their existence. In the absence of any sustained official attempt to come to terms with the wars, war veterans have largely remained unable to make much sense of their involvement in the conflict and of their role in postwar society. Quite ironically, it is one of the most staunchly anti-war non-governmental organizations in Belgrade that developed the only meaningful program aimed at war veterans, and helping them deal with their own psychological issues.

The treatment of ‘partisan hysteria’ in the 1940s Yugoslavia demonstrates the extent to which perceptions of and programs for psychiatric treatment of war trauma depend on the political understanding of wars. In the twentieth century’s culture of universal psychologizing of society and the self, memories of wars tended to be formulated and reinterpreted through the lens of psychological trauma, so that perceptions and the fate of traumatized war veterans or civilians were tightly related to their societies’ collective understanding of the conflicts in question. What happens, though, when the war, which has left hundreds of thousands of victims with severe psychological wounds, has no place in the official memory? Or when, as in Bosnia, over twenty years after it started, the war hasn’t quite ended for so many of its victims? The close relationship between historical memory and treatment of psychological trauma helps to explain the official disregard of mass psychological suffering in the aftermath of the Yugoslav wars in the 1990s. Neither Serbia nor Bosnia has created a stable and coherent political framework for understanding the war, which would make it possible to integrate the issue of war trauma and psychological victimization in the life of the two societies. Certainly, the example of ‘partisan hysteria’ is not one to be followed, but it nevertheless shows that society’s relevance for providing psychiatric and psychological help to war victims and veterans can be intensive and sustained. Maybe there is a way to avoid the overtly political implications of such involvement, and to change the relationship between the politics of memory and the politics of war trauma treatment. It would have to result in the provision of meaningful and considerate psychological assistance to troubled individuals, which would also equip them to become fully-fledged democratic citizens and gain their voice in public discussions of the wars, and it might help these societies overcome their own collective traumas, confusions and denials. This might happen through activities of both the states and a variety of NGOs active in the field of psychology or war memorialization. In this way, re-thinking the meaning and implications of the 1990s war trauma on an individual level could eventually re-shape the collective understanding of the war in a more constructive way.

Mosaic, the new online magazine of the Wellcome Trust recently published a feature article by Penny Bailey titled “Hungary’s Cold War with Polio”, based on Dora Vargha’s research. The BBC and the New Statesman also took up the story. Find out about a more personal take on the Cold War politics of epidemics here.

The 65th annual celebration of World Health Day took place last week on 7th April, with a global launch of the Small Bite: Big Threatcampaign against vector-borne diseases at the WHO’s Geneva headquarters. Over half of the global population is at risk of diseases such as malaria, dengue and yellow fever, all of which are preventable but which but have the biggest impact on some of the world’s poorest people. To highlight the risks to travellers, WHO staff installed a 3-D illustration of a giant mosquito at Heathrow Airport and distributed World Health Day boarding passes to passengers, drawing attention to the danger of vector-borne diseases and the simple measures they can take to protect themselves.

‘World Health Days’, the WHO’s Director-General Margaret Chan told visitors to the launch event in Geneva, ‘provide an opportunity to focus world attention on a health problem or issue that deserves special attention.’ Celebrations over recent years have focussed on antimicrobial resistance, climate change and road safety among other issues.

The first World Health Day took place in 1949, not on 7th April but instead on 22nd July, the date that 61 nations had signed the charter of the World Health Organization at New York in 1946. Documents in the WHO archives suggest that the goal of these early events was less to raise awareness of specific health issues, and more, in the words of the first Director-General Brock Chisholm, ‘to encourage public interest in and support of the aims of the Organization.’[1]

In 1949, individual governments were charged with organising events in their own countries and they took up the challenge with varying degrees of zeal. New Zealand led the way with a range of national and local events organized by branches of its United Nations Association. Ireland, Turkey, Austria, Italy and South Africa also responded, organising radio and cinema broadcasts, concerts, press releases and government-directed bible readings amongst other activities. The WHO headquarters in Geneva provided information about the organisation’s early success in combatting malaria in Italy and Greece, providing tuberculosis vaccines in India and responding to a typhus epidemic in Afghanistan. It also distributed a range of publicity materials and suggestions to national government, including a call to issue commemorative postage stamps (a perennial favourite of international organisations at the time).

Not everyone greeted the event with such enthusiasm however. Some countries felt they hadn’t had enough time to prepare suitable activities, whilst others sensibly pointed out that holding such a celebration when most children were on school holidays would severely blunt its impact. The WHO agreed, and the Second World Health Assembly decided that from 1950 World Health Day would be celebrated on April 7th, to commemorate the date in 1948 when the WHO constitution had officially come in to force.

The decision to link World Health Day to the foundation of the WHO highlights some interesting tensions in the early history of the organisation. In 1949 the US and Venezuela protested that they had been successfully celebrating Pan-American Health Day on 2nd December ever since the foundation of the Pan-American Sanitary Bureau (PASB) in 1902, both suggesting that World Health Day should share the same date. The relationship between the PASB and the WHO was one of the biggest areas of debate at the 1946 New York conference that drew up the WHO constitution. Whilst many delegates, particularly from Europe, emphasised the importance of having a single global health organisation, American states were keen to see the work of the PASB continue. The debate around the issue created significant divisions within the conference, including between Britain and the US. Eventually it was agreed that the PASB would continue as the WHO’s regional office for the American continent, although the exact timescale for its incorporation was left deliberately vague.

Implicit in the connection between World Health Day and the foundation of the WHO was the idea that action in the realm of global health somehow began when the organisation was founded, potentially underestimating the legacy of the various international health bodies such as the PASB which had preceded it. To mark this year’s World Health Day, the in-house magazine for the WHO and the UN in Geneva, UN Special, published an article on the birth of the WHO. It focusses on the meeting between three medical men, Szeming Sze, Geraldo de Paula Souza and Karl Evang, at the United Nations Conference on International Organization in San Francisco in 1945. It quotes Szeming Sze’s memoirs as saying the formation of the WHO “all came about quite accidently”, with the first mention of a new health organisation at the conference coming from Dr. Evang at a lunch meeting between the three men, and that it was their efforts to persuade other delegates that led to the decision to create a world health body.

Microfiche copy from the WHO archives of an early WHO document written on an old League of Nations template

Whilst this account is perfectly accurate, it somewhat downplays the extensive debates that had been taking place for at least the previous three years about the design and role of a future international health body, both within Allied governments and international organisations such as UNRRA. Central to these debates was the example of the League of Nations Health Organization, a body which had made significant contributions to the field of international health in the interwar period and which ultimately provided much of the template for the design of the WHO. It had continued to function in a much reduced form throughout the Second World War and its leading members were active participants in the debate about the shape of a post-war world health body. When the WHO Interim Commission began its work in 1947, it based itself in the same building as the League’s health section, employed many of the same personnel, and as we can see from the document above, even used the same stationery.

Indeed the same vector-borne diseases that the WHO was and is working to combat were also a key focus for the League, which established its own malaria commission in the 1920s. The fact that after nearly a century of international activity these diseases remain such a problem highlights the relevance of this year’s World Health Day campaign.

[1] Documents relating to the history of World Health Day can be found in the WHO archives, Centralized Files First Generation, section 400-1-2. All unattributed material from this post comes from these files.

This workshop is the first in a series of events organised under the umbrella of The Reluctant Internationalists, a four-year project which examines the development and institutionalisation of international collaboration in twentieth-century Europe.

The workshop is co-hosted by Contemporary European History and has three main aims:

First, it attempts to look beyond the self-declared liberal elites to identify other groups who built or dismantled international institutions. The workshop aims to shed light on who these (inter)national agents were, and why, when, and with what results they argued that some form of internationalism was practicable, necessary, or unavoidable.

Second, the workshop seeks to bring into focus alternative chronologies and periodizations of European history. We wish to revisit and revise the by now standard narrative of internationalism’s rise, decline and rise – from its rediscovery in the aftermath of the First World War, and a new enthusiasm for international institutions in the subsequent decade; to its spectacular failure in the era of protectionism, racial conflict and the destruction of the international architecture; to its triumph in the second post-war era; and, after the worst of the Cold War freeze, the flourishing of a new global era in the 1970s. We wish to re-examine variations of this narrative, and recover nuances and pinpoint different trajectories for different international projects.

Third, the workshop seeks to foreground Europe’s place in the history of internationalism. We are particularly interested in how international cooperation has evolved within European nation-states, and how concepts have differed within different parts of Europe and European peripheries.

Each of the seven panels will examine one group with international connections (relief workers, women, children, refugees, collaborators, soldiers, and ‘experts’) and identify continuities and disjunctures in the appeal and application of different internationalist programmes and agendas.

Attendance is free but places are limited. Please contact Ana Antic a.antic@bbk.ac.uk to reserve a space.

We are happy to announce the publication of a special issue about Public Hygiene in Eastern Europe with Jahrbücher für Geschichte Osteuropas, edited by Andreas Renner and Katharina Kreuder-Sonnen.

The articles, published in English and German language, deal with the history of epidemics, public health policies and institutions, the popularisation of hygiene, and eugenics in the 19th and 20th century. The regional focus is on Poland, Tsarist Russia and the Soviet Union. The issue covers a wide range of topics, from anti-cholera campaigns in the Kazakh steppe in the 19th century by Anna Afanasyeva, through the relationship of science and policy in an effort against malaria in Soviet Azerbaijan by Matthias Braun, to German hygienic institutions and colonial agenda in the turn of the 20th century by Justyna A. Turkowska. Katrin Steffen explores the role of experts in developing public health in Poland, Angelika Strobel analyses hygiene propaganda efforts and the evaluation of their effectiveness in Russian provinces, while Birte Kohtz focuses on eugenics in the Soviet Union.

For a complete table of contents and abstracts see http://www.steiner-verlag.de/programm/zeitschriften/jahrbuecher-fuer-geschichte-osteuropas/jgo-6120134.html

Patients on their way to the Matsesta baths from the Sanatorium Krasnaia Moskva in 1928 or 1929. From Sochi: Stranitsy proshlogo i nastoiashchego, ed. A.V. Guseva (Sochi: Muzei istorii goroda-kurorta Sochi, 2007).

The Olympic website for Sochi 2014 (http://torchrelay.sochi2014.com/en/city-sochi) and media coverage occasionally detail the history of the development of Sochi, tying it in the main to the growing popularity of sea bathing in Russia in the early twentieth century. The rise of sea bathing certainly did increase the popularity of the resort, in the context of the rise of tourism on the entire Black Sea coast. But that is only part of the story. The resort was also developed, after the discovery of the presence in Sochi of sulpheric mineral waters at the source “Matsesta,” as a resort for mineral water cures. Many of the first tourists to Sochi were actually patients.

While “taking the waters” is unfamiliar to many people, it was at the time of the first and second waves of development in Sochi – in the 1910s and mid-1930s – still mainstream medical therapy throughout Europe, and continues to be in many places to this day. The mid- to late-nineteenth century saw the rise of the baths, tied to the spread of the railways and increasing accessibility of travel to an expanding bourgeoisie. The circulation of visitors to baths in Central Europe increased dramatically in the 1850s, in the wake of railway construction. The leading baths of Central Europe were Wiesbaden and Baden-Baden, which saw about 30,000 visitors a year each in the 1850s. In Imperial Russia, the railway reached from Rostov-na-Donu to the Caucasian Mineral Waters, an established military resort, in 1875, leading to a burst in the construction of hotels, dachas (summer cottages) and restaurants. That decade the railways also reached the baths of the Austro-Hungarian Empire. In 1888, the railway reached the Black Sea port of Novorossiisk, opening the Black Sea coast of the Caucasus, where Sochi is located, to a new wave of development. As the railways reached out into the flesh of the empires, circulation began to flow domestically and internationally.

As today, the development of the Black Sea coast was spurred by state intervention and investment. The region was in the early twentieth century scarcely populated, and attempts to settle peasants from other places in the empire there as farmers, through various economic and social incentives, were not a success. A particular problem was that malaria was endemic to the region. In the late nineteenth century, Tsar Nicholas II began to ponder targeting the coastline as a site for the development of tourism. But what would draw people to the region?

In 1912, the Tsar sent a large delegation of scientists, including the leading balneologists of the empire, to the region to search for mineral water sources. If mineral waters could be found, perhaps they could serve as a nucleus to draw tourists to the region (and away from rival baths in Central Europe). The delegation reported back that their greatest hopes had been answered. The region was laden with rich deposits of mineral waters, largely untapped. The scientists compared the baths of Matsesta to the baths of Aachen in Western Germany, due to their sulpheric content, a mineral water source called the Kaiserquelle.

The news of the riches of the region, and imperial approval for their development, spread quickly. The first development of the Matsesta waters rested on private capital. A joint stock company was formed to fund the development of the Matsesta mineral waters and in 1912, the first bath house there was opened. Sochi-Matsesta was an ingénue among resorts – aristocrats largely remained loyal to the more established Crimean resort of Yalta or the Caucasian Mineral Waters resort. The Black Sea Coast was particularly attractive to a middle class health resort patient, or kurortnik, as well as patients of the Jewish faith (whose presence was banned at established Imperial Russian resorts). Dachas and villas as well as modest pensions and inns began to be built and there was even some land speculation. Sochi-Matsesta boomed, very briefly, and the development of spa medicine improved when imperial resorts served the front during World War I. The resorts on the Black Sea coast grew from almost nothing at the beginning of the twentieht century through the help of speculators and developers to receive 75,000 visitors in 1912.

A Patient at the Matsesta bath house in the 1920s. From L.G. Gol’dfail’ and I.D. Iakhnin, Kurorty, Sanatorii i doma otdykha SSSR 1928 (Moskva: Gosudarstvennoe izdatel’stvo, 1928).

With the Bolshevik revolution of 1917, the fate of the resorts of the empire seemed unclear. In the nearby Weimar Republic in Germany, for example, despite revolution, the celebrated baths remained largely in the hands of the elite segments of society, beyond the reach of the state. But the Communist party and state was determined to develop health resorts “for the workers.” In 1919, Lenin signed a decree nationalizing all health resorts, which reserved them for the use of the workers, peasants and Red Army soldiers in first order, for medical treatment. Filling the old Tsarist palaces with workers and peasants had obvious propaganda value. In Sochi, sanatoria were established in pre-revolutionary villas, hotels and private clinics (see Figure 1). But the level of state investment in the network of health resorts, and of medical services there, make it clear that this was not a mere “Potemkin village.” The state, and particularly the committed physicians at the head of the new, state public health ministry, the Commissariat of Public Health, took health resort medicine seriously, not least mineral water treatments, as a way to improve the health of the entire population.

The use of the Matsesta waters increased dramatically, largely due to patients sent for a “cure” by the Commissariat of Public Health (See Figure 2). In the 1920s, a cure usually lasted from four to six weeks, and included from 15 to 30 baths with Matsesta waters. Physicians sent patients to Matsesta to cure chronic eczema and other skin conditions, gout, various nervous ailments, syphilis, chronic rheumatism, gynecological ailments and ailments of the heart, circulation and digestion, but patients also took the waters of their own accord, “off label,” for whatever ailed them. The number of patients using the Matsesta waters increased from 67 in 1920, to 3,921 patients in 1925. The most rapid expansion, however, came during the years of industrialization of the late 1920s and 1930s: from 1927 to 1932 the number of patients taking the Matsesta cure increased from 7,980 patients to 48,574 patients. The number of baths taken increased from 1921 to 1932 from 1,345 baths to 731,218 baths. A second bath house was built. But demand outpaced supply. By 1937, the Matsesta bath houses were working from 6 a.m. until 11 p.m.

The Soviet leaders were justifiably proud of their accomplishment, but rather overstated their role in developing the resort. Frequently not included in Soviet statistics were numbers from the pre-Revolutionary period: 18,604 baths were administered in 1913, 17,395 baths in 1914, 16,982 baths in 1915 and 21,586 baths in 1916. Indeed, the pre-revolutionary peak in 1916 was not reached in the Soviet Union until 1923. In the 1920s and 1930s, as now, the idea that the resort was “new” served the symbolic project of treating their development as a display of state power. Patients continue to take the cure at the Matsesta waters to this day (See Figure 3).

The bath house “Staraia Matsesta” in 2009. Photograph taken by the author

The British Library has launched a new website on the history and culture of World War I and its legacy. The website is rich in visual sources, drawing on the extensive collections of the Library. The site explores eight key themes (such as Life as a soldier, Civilians, Race, empire and colonial troops, Representation and memory) through nearly 500 historical sources and over 50 articles on the history of WWI.

Articles and sources can be found through the key themes, through browsing and through the search tool of the website. The project also includes an extensive section on teaching resources with downloadable packs for class discussion, including reading suggestions, key questions and suggested activities.

Dora Vargha’s blog post on November 25th discussed the current financial difficulties faced by the Peto Institute in Budapest in the context of historical approaches to disability in Hungary. The Institute may be familiar to British readers who remember its rise to prominence in the late 1980s and its role in the debate around conductive education in the treatment of children with neurological disorders. The links between the UK and the Peto Institute provide a fascinating example of patient-led transnational history in Cold War Europe.

Princess Diana at the Peto Institute (1990)

The Institute first came to public attention following the broadcast of the BBC documentary Standing up for Joe in April 1986. The documentary followed the story of the Hadley family who had taken their severely disabled son to Budapest for treatment. The Institute pioneered the system of conductive education developed by its founder, Andras Peto, in the aftermath of the Second World War, which involved an intensive programme of physical and speech therapy under the supervision of “conductors” combined with very high expectations of the progress children could achieve.

The documentary, broadcast at prime time on BBC1 and watched by over five million people, caused a national stir. The BBC received 11,000 letters of enquiry, questions were asked in parliament, and a lobby group, the Foundation for Conductive Education, was set up to promote its use in the UK. The system was presented in the media as more holistic than the medicalised approach to treatment in the UK, and many parents were attracted by the positive expectations it had of potential progress against a perceived negativity and conservatism amongst UK medical staff. Over the following years UK families flocked to Budapest, often supported by national and local campaigns to raise funds for treatment. The Times estimated that over 600 UK children had visited the centre by 1990.

However, the treatment was not without controversy. Many within the British medical establishment felt that the claims for its success were overblown, and that the appearance of progress owed much to the fact that the Institute was selective in the cases it accepted. The Chartered Society of Physiotherapy published a report in 1988 questioning many of the Institute’s claims, whilst the Spastics Society, initially wary of the programme, was picketed by the Foundation for Conductive Education over claims that its own conductive education schemes weren’t the real thing.

One of the most interesting features of the coverage of the Institute is its presentation in the context of the Cold War. Andrew Sutton, the Director for the Foundation for Conductive Education, described it as a ‘Len Deighton Cold War story, coming from a street near you’, with the media frequently describing families moving “beyond the iron curtain”. It certainly represents one of the most widespread and high profile instances of UK residents experiencing life in the Eastern Bloc prior to the end of communism. The BBC’s follow-up documentary to Standing up for Joe broadcast in 1987, which tracked the story of the British families who had followed in the Hadley’s footsteps, was entitled To Hungary with Love.

The Peto Institute also played a role in Anglo-Hungarian relations during the transition to democracy. In December 1989 the UK government announced £5 million of funding for the Institute’s new international centre to guarantee places for British children and pay for training of a group of British conductors. This funding was discussed as part of a wider package of support when Hungarian Prime Minister Miklos Nemeth visited Margaret Thatcher on December 14th. In an article on the 6th January, The Times presented the funding as part of a range of government measures to form closer medical and scientific links with the Soviet Union and Eastern Bloc countries. Following the first free elections in March 1990, Princess Diana made a high profile visit to the Institute as part of a four-day tour of Hungary where she presented an honorary OBE to its director, Dr Maria Hari.

The controversy around conductive education has never entirely gone away. In 1993 the government-commissioned Birmingham Project indicated that it was no more effective than comparable UK treatments, a claim that continues to be challenged by its adherents, whilst in 2003 Peter Randall from Kent attempted to sell his kidney on ebay to fund conductive education for his daughter. Although conductive education is now more widely available in the UK, British children continue to visit to Peto Institute for treatment.